July 26, 2021
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How dry I am - Dry mouth

The Wealth of Health

George Malkemus
This thrush is no songbird
June 11, 2021

A thrush is a bird known for its beautiful songs; however, there is another type of thrush that will have you singing out of tune: a fungal infection.

Thrush is an infection of the mouth caused by the Candida fungus, which grows out of control and causes painful lesions usually on the inner checks and tongue, but can also spread to the roof of the mouth, gums, tonsils and throat. Symptoms of thrush include pain, difficulty swallowing a feeling that food gets stuck in the throat and fever.

People of all ages can contract thrush, though it occurs most often in infants, the elderly and anyone who has a suppressed immune system. Candida infection is not limited to the mouth; it can occur in other parts of the body as well, causing diaper rash in infants or vaginal yeast infections in women.

What causes thrush?

Small amounts of the Candida fungus are present in the mouth, digestive tract, and skin of most healthy people and are normally kept in check by a balance of bacteria and microorganisms in the body. However, certain illnesses, stress, or medications can disturb the delicate balance, causing the Candida fungus to grow out of control, causing thrush. Diseases or medical situations that make Candida infection more likely to develop include uncontrolled diabetes, HIV infection, cancer, or pregnancy caused by the hormonal changes that occur with pregnancy. 

Many medications that caused reduced saliva production called dry mouth, can allow the fungus to grow without the normal healthy cleaning functions of saliva. Medications that upset the balance of microorganisms in the mouth that may cause thrush include corticosteroids, antibiotics, chemotherapy medications, immunosuppressant drugs, and birth control pills. 

People who wear dentures that don't fit properly are at increased risk for thrush.  The Candida fungus can grow on the underneath of a denture when not properly and regularly cleaned, often in individuals who rarely remove their dentures.  The infection will originate on the tissue under the dentures and then spread to other areas of the mouth.

Sometimes antibiotic use can change the oral environment, killing good bacteria and lead to fungal growth, thrush.  Even using too much antimicrobial mouthwash can bring on a case of thrush, usually when other medical factors are involved.

Also smoking greatly increases the risk for thrush, as well as many other diseases.

What are the signs of thrush?

It is easy to spot thrush because it produces slightly raised, creamy white clumps that look like cottage cheese on the tongue, gums, cheeks, throat, tonsils and/or roof of the mouth.  The cottage cheese looking clumps can be painful and may bleed slightly when scraped or brushed.  Thrush usually develops suddenly, but it may become chronic, persisting over a long period of time, particularly in denture wearers, since the Candida fungus can become embedded in the underside of the denture.

Thrush is common in infancy, during which time the normal microorganism balance in the mouth is developing. In addition, babies can pass the infection to their mothers during breast-feeding, since the disease is contagious.  With an infant, thrush usually goes away without treatment in a few weeks, but should be checked by their pediatrician.  

For an adult, if thrush is left untreated, the fungus can spread to other parts of the body. The infection may spread into the throat causing painful, difficult swallowing and possibly fever. In severe cases, it has been known to invade the lungs, eyes, joints, liver, heart and even the brain.  This happens more often in people with cancer, HIV, or other conditions that weaken the immune system.

How is thrush treated?

While healthy children and adults can be effectively treated for thrush, the symptoms may be more severe and difficult to manage in those with weakened immune systems. Anti-fungal medications, which are generally taken for 10 to 14 days, are usually prescribed to treat thrush. These medicines are available in tablets, lozenges or liquids.  Extensive cleaning and relining or replacement of infected dentures is necessary for an infected denture wearer.   

I treated an 81-year old woman with a loose fitting upper denture with severe soreness on the roof of her mouth.  The sore on her palate was a cottage cheese white with redness and bleeding, indicating Candida infection.  I prescribed Nystatin, anti-fungal tablets.  Her denture was old, worn and ill fitting.  Underneath the denture, the denture material was rough and impregnated with Candida fungus.  A new denture was made that fit great.  Now she is happily infection free, smiling more and chewing better. 

Underlying medical problems causing thrush

Sometimes the presence of Candida infection can be a symptom of other medical problems.  Depending on the patient’s age, medical history, cause and severity of the infection, a patient should be sent to their physician to diagnose and treat any underlying health problems.

About ten years ago, I saw emergency patient, a 23-year-old young man, with extreme mouth pain.  His entire mouth was covered in cottage cheese-like, white puffy clumps.  No pink tissue could be seen.  His tongue looked like a swollen white ‘Hostess Snow Ball.’  He had severe Candida infection.  He had no known medical problems and was on no medications.  But I definitely knew that he had some underlying medical problem to allow such an advanced fungal infection.  I prescribed pain and anti-fungal medications and arranged for him to immediately go to the emergency room.  There he was found to have a complete kidney shut down.  He was quickly admitted into the hospital and put on dialysis.  His internist later told me that if he had delayed a few more hours, he would not have survived.     

Thrush is just one more good reason to make and keep those regular dental check-up appointments.  With a healthy mouth you can sing a sweet song like a thrush, the songbird!


 Enjoy Life and Keep Smiling!


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at